InsuranceComplaintCheck

Aetna — Insurance Complaint Report

Aetna faces above-average complaints, primarily concerning health coverage and billing issues.

Key Metrics

AI Insurer Analysis

Aetna has accumulated 528 insurance complaints on record. Their NAIC complaint ratio of 1.25 is above average, meaning they receive more complaints than expected for an insurer of their market size. With approximately 3.8% market share, Aetna is a mid-sized player in the insurance market. The most common complaint categories are: health (20). Aetna shows an above-average complaint ratio, indicating more complaints than expected for its size. The majority of complaints are related to health coverage, with 'Premium increase' and 'Billing error' being the most frequent sub-types. A significant portion of complaints are recent, with 20 complaints logged within the specified date range. Geographic distribution of complaints is spread across multiple states, with no single state dominating. Aetna's complaint trends indicate a higher-than-average volume, with a focus on health-related billing and premium adjustments. Areas of concern include: Above-average complaint ratio suggests potential systemic issues.; Concentration of complaints in 'Premium increase' and 'Billing error' warrants further investigation into Aetna's pricing and billing practices.. On the positive side: Claim denial rate is low.; No recent regulatory actions reported..

Risk Breakdown

Red Flags

Green Flags

Consumer Tips

When dealing with Aetna, keep these practical tips in mind: 1. Carefully review all premium increase notices and understand the reasons behind them. 2. Scrutinize your bills for any discrepancies and promptly dispute any errors. 3. Understand the prior authorization process for health services to avoid coverage gaps. 4. Keep detailed records of all communications with Aetna regarding claims and billing. Before purchasing a policy, compare Aetna's complaint ratio (1.25, above average) with competitors offering similar coverage. Always read the full policy document, paying attention to exclusions and limitations. Document all communications with the insurer in writing. If you experience a dispute, file a complaint with your state Department of Insurance — it is free and often results in faster resolution.

Trend Analysis

Aetna's complaint trends indicate a higher-than-average volume, with a focus on health-related billing and premium adjustments.

Frequently Asked Questions about Aetna

Is Aetna a good insurance company?

Aetna has 528 complaints on record. Their NAIC complaint ratio is 1.25, which is above average. They hold approximately 3.8% market share. A complaint ratio below 1.00 indicates fewer complaints than expected for a company of this size; above 1.00 indicates more.

What are the most common complaints about Aetna?

The most common complaint categories for Aetna are: health (20). The leading specific issues are: Premium increase (5), Billing error (4), Claim denial (3).

How does Aetna compare to competitors?

Aetna's NAIC complaint ratio of 1.25 is above average. Companies with ratios below 1.00 receive fewer complaints relative to their size. When comparing insurers, also consider financial strength ratings, coverage options, and premium pricing alongside complaint data.

Should I file a DOI complaint against Aetna?

If you have an unresolved dispute with Aetna, filing a complaint with your state Department of Insurance (DOI) is a free and effective option. Steps: (1) Gather all documentation including your policy, correspondence, and claim records. (2) Contact your state DOI — most Aetna complaints come from North Dakota. (3) File online or by mail. (4) The DOI typically responds within 30-45 days.

Are Aetna complaints getting better or worse?

Aetna has 528 total complaints. In the most recent data, 20 complaints were recorded across 1 coverage categories. Check the NAIC Consumer Information Source for the most current complaint ratio trends.

What insurance companies have the lowest complaint ratios?

Insurance companies with the lowest complaint ratios typically include mutual insurers and member-owned companies. To find alternatives to Aetna, compare NAIC complaint ratios for companies offering the same coverage types (health, etc.). Your state DOI website provides complaint data specific to companies licensed in your state.

Has Aetna been fined or sanctioned by insurance regulators?

Regulatory action information is available through your state Department of Insurance and the NAIC. Aetna has 528 consumer complaints on record with a complaint ratio of 1.25. For specific regulatory actions, check the NAIC Regulatory Actions database and your state DOI enforcement records.

Which states have the most complaints against Aetna?

The states with the most complaints against Aetna are: North Dakota (3), Missouri (2), Georgia (1), Nevada (1), Arizona (1). This distribution may reflect the company's market presence in those states rather than indicating worse service in specific locations.

What patterns emerge from Aetna's complaint data?

The complaint data spans a very recent period, suggesting these issues are current.

How does Aetna handle claims compared to peers?

Despite a high complaint ratio, specific issues like claim denials are infrequent.

What is the complaint trend for Aetna?

Aetna's complaint trends indicate a higher-than-average volume, with a focus on health-related billing and premium adjustments.

What should prospective policyholders know about Aetna?

The 'Premium increase' sub-type is a notable driver of dissatisfaction.

Are there systemic issues in Aetna's complaint history?

The insurer's response time appears to be generally good, as indicated by the 'good' rating.

Recent Complaints Against Aetna

Aetna Complaints by State

Aetna Complaints by Coverage Type

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This analysis is based on NAIC complaint data and AI interpretation. Not legal, financial, or insurance advice.